MEDICARE: JESSIE ALLAN LEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E.2303972	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	163042	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972020790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE ALLAN LEU

Provider Business Mailing Address
First Line	:	9399 BASSWOOD DR
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2577
Country	:	US
Telephone Number	:	330-554-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 LORAIN AVE STE 407
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3726
Country	:	US
Telephone Number	:	216-250-1607
Fax Number	:	216-304-6669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	10/20/2025

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Directions to “ JESSIE ALLAN LEU ” Practice Location

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